How much does Medicare pay for CPT 27130?

Medicare allowed an average of $1465.84 per service and paid $1165.45 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $9340.88, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 27130?

Replacement of thigh bone and hip joint with prosthesis. It was billed 286,125 times to 278,183 Medicare beneficiaries by 8,193 providers in 2024.

Does 27130 pay differently in an office than a hospital?

Yes. The allowed amount averaged $923.63 in an office setting and $1468.23 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 27130 most?

Orthopedic Surgery, with 164,713 services from 4,513 clinicians. Next are Physician Assistant, Ambulatory Surgical Center, Nurse Practitioner.

CPT 27130

Replacement of thigh bone and hip joint with prosthesis

$1465.84Medicare-allowed amount per service, averaged across 286,125 services

Providers submitted

$9340.88

Asking price, not received

Medicare allowed

$1465.84

The fee schedule figure

Medicare paid

$1165.45

Balance is patient coinsurance

Providers submitted an average of $9340.88 for this code and Medicare allowed $1465.84 — 6.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $1165.45 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $923.63
Hospital / facility: $1468.23

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,252 services were billed in an office setting and 284,873 in a facility.

Services: 286,125
Beneficiaries: 278,183
Providers billing it: 8,193
Total allowed: $419,413,470

What Medicare pays for CPT 27130

Across 286,125 services billed by 8,193 providers to 278,183 beneficiaries, Medicare allowed an average of $1465.84 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 27130

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	164,713	159,725	$1225.75	4,513
Physician Assistant	85,529	83,571	$173.01	2,742
Ambulatory Surgical Center	22,491	21,833	$8849.19	494
Nurse Practitioner	11,437	11,158	$167.49	386
Sports Medicine	846	820	$1282.04	30
General Surgery	420	406	$514.28	10
Osteopathic Manipulative Medicine	291	278	$1203.84	5
Certified Clinical Nurse Specialist	154	151	$160.09	3
Family Practice	150	149	$313.55	5
Obstetrics & Gynecology	43	41	$204.77	2
General Practice	24	24	$1230.42	1
Surgical Oncology	14	14	$1098.85	1
Pediatric Medicine	13	13	$196.15	1

27130 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	23,526	$1521.95	$1222.86	601
California	22,560	$1475.09	$1035.22	582
Texas	14,083	$1240.60	$1013.79	463
New York	13,114	$1414.59	$1053.12	356
Illinois	12,525	$1451.83	$1124.23	354
Pennsylvania	12,175	$1259.42	$1006.90	335
Ohio	11,108	$1570.72	$1310.39	353
North Carolina	10,009	$1440.36	$1217.20	312
Virginia	9,923	$1491.29	$1226.61	227
Arizona	8,080	$1632.44	$1333.11	213
Massachusetts	8,062	$1255.49	$954.07	206
Washington	8,057	$1392.23	$1070.38	242
New Jersey	7,846	$1511.50	$1133.29	191
Indiana	7,631	$1689.27	$1449.35	239
Georgia	7,358	$1955.69	$1590.70	207
Maryland	7,043	$1845.25	$1442.41	174
Tennessee	6,976	$1938.27	$1749.65	193
Michigan	6,796	$1793.38	$1477.40	234
South Carolina	6,448	$1431.66	$1218.35	149
Colorado	6,439	$1295.05	$1035.31	190
Wisconsin	5,869	$1343.56	$1141.06	219
Missouri	5,006	$1373.37	$1157.00	156
Minnesota	4,563	$1625.46	$1319.68	192
Kansas	4,429	$794.99	$680.01	124
Iowa	4,220	$962.45	$834.47	125
Oregon	4,075	$2161.48	$1682.39	114
Oklahoma	3,435	$865.54	$741.89	93
Kentucky	3,267	$1467.56	$1241.74	94
Nebraska	3,259	$898.15	$779.72	82
Connecticut	2,926	$1619.53	$1215.53	104
Utah	2,641	$1263.98	$1054.44	96
Arkansas	2,634	$1093.94	$961.03	75
Alabama	2,615	$782.27	$703.64	101
New Hampshire	2,588	$2104.30	$1706.15	68
Mississippi	2,552	$2844.96	$2601.13	64
Idaho	2,500	$1049.56	$901.79	74
Nevada	2,397	$1741.93	$1408.51	56
Louisiana	2,358	$1028.80	$872.85	85
Montana	2,310	$1930.72	$1602.74	52
South Dakota	2,008	$689.75	$584.72	60
Delaware	1,758	$1167.60	$930.19	38
Maine	1,336	$1043.63	$856.73	47
North Dakota	1,329	$1210.87	$1028.59	39
New Mexico	1,095	$1043.02	$860.20	33
Alaska	1,052	$1609.69	$1183.90	38
Rhode Island	994	$1771.54	$1422.97	36
Wyoming	880	$1558.71	$1280.20	31
West Virginia	861	$1323.82	$1104.30	33
Vermont	533	$859.10	$717.05	17
District of Columbia	447	$1206.21	$864.71	12
Hawaii	408	$2392.02	$1805.50	13
Puerto Rico	21	$215.13	$144.44	1

Related codes

27134Revision of thigh bone and hip joint prosthesis$1465.89

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.